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Semester 5 PMNM Exam 8 > Spinal Cord Injury 1 > Flashcards

Spinal Cord Injury 1 Flashcards

1
Q

SCI most common cause

A

MVC

Falls is next

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2
Q

Mechanism of Injury

A

Hyperflexion
Hyperextension
Compression
Excessive lateral bending or rotation

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3
Q

Mechanism of Injury - Hyperflexion

A

Post ligament tears and dislocates

Complete SCI in about 1/3 of flexion injuries

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4
Q

Mechanism of Injury - Hyperextension

A

Anterior ligament tears

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5
Q

Mechanism of Injury - compression

A

Crushing of vertebrae
Bony fragments can go into spinal cord and cause damage
75% chance of complete SCI

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6
Q

Mechanism of Injury - Trauma - Transection causes

A

Glia disrupted
Spinal cord tissue torn
Can be caused by penetrating trauma, blunt trauma, bony fragment, disc herniation

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7
Q

Mechanism of Injury - Compression causes

A

Violent shaking or direct blow

Temporary loss of function

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8
Q

Mechanism of Injury - Contusion

A

Glial tissue and spinal cord surface are intact
May have loss of central grey and white matter
Created cavity with white matter rim at periphery

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9
Q

Mechanism of Injury - Vascular Injury

A

Suspect if discrepancy between clinical neuro deficit and level of spinal injury

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10
Q

Mechanism of Injury - Vascular injury - examples

A

Lower cervical dislocation compresses vertebral arteries within spinal foramina of vertebrae
Thrombosis

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11
Q

Pathophysiology - Primary injury

A

Damage that occurs immediately at time of injury

Spared tissues and axons may remain and are important in recovery

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12
Q

Pathophysiology - Primary injury - Forces

A 
Compression
Contusion
Shear
Penetrating 
Gun shot wound that does not enter the spinal cord
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13
Q

Pathophysiology - Secondary injury

A

Begins within minutes
Evolves over hours
Can be from:
Ischemia, hypoxia, inflammation, edema, electrolyte disturbances

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14
Q

Pathophysiology - Secondary Injury - examples of electrolyte distrubances

A

Intracellular Ca inc
Extracellular K inc
Na permeability inc

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15
Q

Pathophysiology - Secondary injury - Blood flow changes

A 
Within 2 hours
Dec spinal cord blood flow
Rapid swelling at injury level
Pressure on cord becomes higher than venous pressure
Ischemia 
Necrosis
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16
Q

Pathophysiology - Secondary injury - Edema occurs

A

Within hours of injury

First and injury site and then spreads to adjacent and distant segments

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17
Q

Clinical Presentation

A

Depend on mech of injury
Typically pain at injury site, but not always
Often associated brain and systemic injuries
About 1/2 of traumatic SCI are cervical

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18
Q

Treatment of SCI - initial treatment is what

A

C spine immobilization!
CABs
Full spine immobilization

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19
Q

Clearing airways with pt with SCI

A

Modified jaw thrust to make sure to keep C spine in line

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20
Q

SCI - Consults

A 
Neurosurgeon
Orthopedics
Trauma specialist
General surgeon
Others as needed
An patient will be admitted
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21
Q

SCI - imaging

A

X ray
CT
MRI

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22
Q

SCI - Clinical localization - Complete cord injury

A

Transection of cord that can come from severe compression, or extensive vascular dysfunction
Complete loss of sensory and motor function below level of lesion

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23
Q

SCI - Clinical localization - Complete cord injury - ASIA grade

A

A

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24
Q

SCI - Clinical localization - Complete cord injury - Acute stages

A 
Absent reflexes
No response to plantar stimulation
Flaccid mm tone
Male - priapism
Urinary retention and bladder distension
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25
Q

SCI - Clinical localization - Incomplete cord injury

A

Contusions, edema, bony fragments

Partial loss of sensory and motor function below level of lesion

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26
Q

SCI - Clinical localization - Incomplete cord injury - ASIA grade

A

B to D

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27
Q

SCI - Clinical localization - Incomplete cord injury - sensation and motor function

A

Various degrees of muscle motor function
Various degrees of sensation in dermatomes
Usually sensation is preserved more than motor function

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28
Q

SCI - Neurological level and completeness of injury with recovery

A

More incomplete the injury = more favorable the potential for recovery
Esp. on initial eval at 72 hrs to 1 wk after injury

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29
Q

SCI - Deficits determined by neurologic levels/lesions

A

Tetra/Quad - spinal cord segment C1-C8

Para - Thoracic, lumbar, or sacral segments

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30
Q

Spinal Cord Syndrome - Central Cord Syndrome

A

Damage central part of SC

Peripheral fibers not affected

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31
Q

Spinal Cord Syndrome - Central Cord Syndrome - often caused by

A

Often from cervical hyperextension with pre existing cervical spondylosis

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32
Q

Spinal Cord Syndrome - Central Cord Syndrome - s/s

A

More severe motor impairments in UE then LE
Bladder dysfunction
Variable sensory loss below injury level

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33
Q

Spinal Cord Syndrome - Central Cord Syndrome - s/s with tracts

A

Loss of pain and temp at site of injury and surrounding dermatome due to crossing of spinothalamic
Dermatome above and below will have intact pain and temp
Vibration and proprio often spared

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34
Q

Spinal Cord Syndrome - Anterior Cord Syndrome -

A

Often due to loss of blood supply from anterior spinal artery

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35
Q

Spinal Cord Syndrome - Anterior Cord Syndrome - Corticospinal tract

A

Weakness and reflex changes

bilateral loss motor function

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36
Q

Spinal Cord Syndrome - Anterior Cord Syndrome - Spinothalamic

A

Pain and temp loss bilaterally

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37
Q

Spinal Cord Syndrome - Anterior Cord Syndrome - Tactile, position, and vibratory sense

A

Normal

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38
Q

Spinal Cord Syndrome - Anterior Cord Syndrome - Caused by

A

Flexion injuries
Intervertebral disc herniation
Spinal cord infarction
Radiation myelopathy

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39
Q

Spinal Cord Syndrome - Posterior Cord Syndrome - Causes

A

MS, Friedreich ataxia, tabes dorsalis

Tumors, cervical spondylotic myelopathy

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40
Q

Spinal Cord Syndrome - Posterior Cord Syndrome - Corticospinal

A

If actue - weakness, muscle flaccidity, hyporeflexia

If chronic - mm hypertonia, hyperreflexia

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41
Q

Spinal Cord Syndrome - Posterior Cord Syndrome - s/s

A

Loss of proprioception - wide based gait ataxia
Loss of vibratory sensation
Bladder dysfunction
Paresthesias

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42
Q

Spinal Cord Syndrome - Brown Sequard syndrome

A

Unilateral involvement
Dorsal column
CST, spinothalamic tract

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43
Q

Spinal Cord Syndrome - Brown Sequard syndrome - s/s

A

Weakness, loss of vibration and prop (same side)

Loss pain and temp (opp side)

44
Q

Spinal Cord Syndrome - Brown Sequard syndrome - causes

A

Knife or gunshot wound
Demyelination
Disc herniation, infarction, infection, tumors

45
Q

Spinal Cord Syndrome - Conus Medullaris syndrome

A 
Sacral cord injury
L2 lesion - often affects conus medullaris 
Early prominent sphincter dysfunction
Flaccid paralysis of rectum and bladder
Impotenence 
Saddle anesthesia
Leg muscle weakness (mild)
46
Q

Spinal Cord Syndrome - Conus Medullaris syndrome - causes

A

Disc herniation
Spinal fracture
Tumors

47
Q

Spinal Cord Syndrome - Cauda Equina Syndrome

A

Medical Emergency!
Injury of LS nerve roots
Loss of function of 2 or more of the 18 nerve roots in the cauda equina
Usually central lumbar disc herniation
Low back pain with radiation to one or both legs
Weakness of PF with loss of ankle jerks
Bladder and rectal sphincter paralysis (usually S3 to 5)
Sensory loss in dermatomes of affected nerve roots
Saddle anesthesia

48
Q

Spinal Cord Syndrome - Cauda Equina Syndrome- what do you do

A

True medical emergency!

Refer to neurosurgery

49
Q

Spinal Cord Injury - Syringomyelia - how many para and how many tetra

A

2% of para
0.2% of tetra
Is a clinical syndrome

50
Q

Spinal Cord Injury - Syringomyelia - most commonly seen where

A

Thoracic area

51
Q

Spinal Cord Injury - Syringomyelia - Caused by

A

Cystic cavitation and gliosis of SC

Cysts may grow and become tubular to extend additional spinal levels

52
Q

Spinal Cord Injury - Syringomyelia - occurs commonly when

A

Within 4-9 years post trauma

Can develop up to 30 years after initial lesion though

53
Q

Spinal Cord Injury - Syringomyelia - S/S

A

Initially sharp pain
Might have LMN dysfunction
Sensory loss is common
Horners syndrome (ipsilateral ptosis, miosis, anhydrosis)

54
Q

Spinal Cord Injury - Syringomyelia - S/S that they may have

A 
spasms
reflex changes
phantom sensations
sexual dysfunction
spasticity of mm
mm wekaness
cape like distribution
HA
b/b control loss
sensation loss in hands
55
Q

SCI - Neurapraxia

A 
Transient neuro deficits
Transient tetra (from axial loading
Athletic injuries common
Sudden decrease in AP diameter of the spinal canal - compression of cord
Seen both with hyperext and flex
56
Q

SCI - complications

A 
Cardiac
Resp.
DVT
Autonomic Dysreflexia
Spasticity
Integumentary
B/B dysfunction
57
Q

SCI - reflexes

A

Initial loss of function and reflex function
1st 2-3 wks - no spinal reflexes
Slowly over time hyperreflexia when the mm tone inc
Spasticity can develop

58
Q

SCI - Spinal Shock

A

Transient physiological deficit of cord function below level of injury
Complete loss of neuro function

59
Q

SCI spinal shock - s/s

A

Initially - tachycardia and HTN - due to catecholamine release
Bradycardia, hypotension
Paralysis, b/b dysf, priapism

60
Q

SCI - neurogenic shock

A

Severe autonomic dysfunction
Interruption of sympathetic nervous system
Usually does not occur with injury below T6

61
Q

SCI neurogenic shock - ss

A 
Hypotension
Bradycardia
Peripheral VD
Hypothermia
Priapism
Dec temp reg below injury
B/B incontinence
62
Q

Shock with spinal cord injury below T6

A

Consider hemorrhagic until proven otherwise!

63
Q

Management SCI

A

Loss of sympathetic tone

Due to loss of vascular tone so can be mildly hypotensive or mildly bradycardic

64
Q

Management SCI - Goal

A

Ideal MAP at least 90
Fluids but not over
Vasopressors (dopamine)
Maintain blood supply to spinal canal

65
Q

SCI - BP for injuries above T6

A

Baseline BP is reduced

Baseline HR is reduced (50-60)

66
Q

SCI - BP for injuries above T6 - consideration

A

Hemodynamic instability

Exercise intolerance

67
Q

SCI - orthostatic hypotension

A

Need to have evaluated BP and pulse
Dec sys BP more than 20
Dec dias BP more than 10

68
Q

SCI - orthostatic hypotension - Chronic SCI

A

Excessive bed rest

Diminished fluid intake

69
Q

SCI - orthostatic hypotension - s/s

A

dizzy

lightheaded

70
Q

SCI - orthostatic hypotension - tx

A 
Place them in supine
If able to raise legs
Tup wc to lower head
Assess vitals
Assess s/s
71
Q

SCI - orthostatic hypotension - prevention

A

Gradual change positions

Dec venous pooling - TED hose, abdominal binders

72
Q

Cardiovascular complications - Autonomic Dysreflexia

A

Medical emergency!!
Occurs in SCI above T6
Uninhibited sympathetic response to stimuli
Leads to diffuse VC and causes HTN so then they
Compensate with parasympathetic response above lesion (brady, VD) but not enough to compensate for symp response

73
Q

Cardiovascular complications - Autonomic Dysreflexia - frequency

A

20-70% of patients with SCI lesions above T6

74
Q

Cardiovascular complications - Autonomic Dysreflexia - when seen

A

Unusual to be seen in first month

Usually seen within first year

75
Q

Cardiovascular complications - Autonomic Dysreflexia - Stimuli

A 
Bladder distension
Bowel impaction
Pressure sores
Bone fracture
Occult visceral disturbances
Sexual activity
Gynecological - labor, delivery, menstruation
76
Q

Cardiovascular complications - Autonomic Dysreflexia - s/s

A 
HA
HTN
Brady
Diaphoresis
Flushing
Piloerection
Blurred vision
Nasal obstruction
Anxiety
Nausea
77
Q

Cardiovascular complications - Autonomic Dysreflexia - complications

A 
Asymptomatic HTN
HTN crisis
Brady
Cardiac arrest
Intracranial hemorrhage
Seizures
78
Q

Cardiovascular complications - Autonomic Dysreflexia - severity and frequency

A

depends on SCI

79
Q

Cardiovascular complications - Autonomic Dysreflexia =

A

LIFE THREATENING!

Med emergency

80
Q

Cardiovascular complications - Autonomic Dysreflexia - management

A 
Check BP
If safe, sit them up
Remove tight clothes
Search for cause - check urinary catheters
Meds if needed
81
Q

Cardiovascular complications - Autonomic Dysreflexia - management - medications

A 
Nitrates
Nifedipine
Captopril
Hydralazine
Labetalol
82
Q

Cardiovascular complications - Autonomic Dysreflexia - what is key

A

Recognize it and avoidance of causative stimuli

83
Q

Cardiovascular complications - CAD - incidence

A

3-30 times more with SCI patient

84
Q

Cardiovascular complications - CAD - risk factors

A 
Lipid profile (low H, High L) 
Glucose metabolism (impaired glucose tolerance, insulin resistance, diabetes)
85
Q

Cardiovascular complications - CAD - contributing factors

A

Dec mm mass
Inc fat
Inactivity

86
Q

Cardiovascular complications - CAD - mortality

A 
Greater in SCI patients
Lesions above T5
Atypical s/s cardiac ischemia
Autonomic dysreflexia
Changes in spasticity
87
Q

Cardiovascular complications - CAD - cardiac arrhythmias

A

Acute - due to excess vagal tone, hypoxia, hypotension, fluid and electro imbal
Less frequent with chronic
Complete - ongoing risk factor of cardiac arrest

88
Q

Pulmonary complications - ventilatory function

A

Resp mm impacted (cervial and high thoracic)
Need for assisted vent depends on level and severity of SCI
Dyspnea
Exercise intolerance
Impaired cough
Lung secretions
Inc risk of pneumonia

89
Q

Pulmonary complications - DVT

A

Common early complication
Often from lack of movement
PE leads to death

90
Q

Pulmonary complications - DVT - Prevention

A 
Exercise - early mob
Turning in bed
Prophylactic use of heparin for at least first 3 months
TED hose
Sequential compression devices
Foot pumps
IVC filter
91
Q

Pulmonary complications - DVT - S/S

A 
Calf pain
Edema or swelling
Warmth
Tenderness
Erythemia
Palpable cord
Homans sign is unreliable 
All of these are nonspecific
92
Q

Pulmonary complications - DVT - What do you do if you think there is one

A

Stop mob
Report findings
Doppler US
Blood tests

93
Q

Temp Regulation complication due to

A

disruption of autonomic pathways they have trouble regulating their temp

94
Q

Temp Regulation complication - most vulnerable

A

SCI T6 and above

95
Q

Temp Regulation complication - impaired ___ mechanism

A

Cooling
Loss of sympathetic system
- Insensate skin - impaired vasomotor and sudomotor (sweat gland) responses
- Reduced sweating
Autonomic dysfunction below lesion and limited or loss of skeletal muscle pump action (paralysis)
- Impaired redistribution of blood
- Decreased venous return
Increased metabolic heat – exercising muscles

96
Q

Temp reg comp - conditions

A 
Exercise - hyperthermia
Hot ambient temp - hyperthermia
Cold ambient temp - hypothermia 
Infection
Episodic hyper or hypothermia
97
Q

Temp reg complication - Tx - depends on condition - Hyperthermia

A

Remove from hot environment
Heat cramps
Heat exhaustion
Heat stroke - med emergency

98
Q

Temp reg complication - Tx - depends on condition - hypothermia

A 
Core body temp below 95F
Remove from cole environ
Passive external rewarming
If mod or severe get med attn
Monitor closely
99
Q

Urinary complications - Bladder dysfunction

A

Affects urine storage and emptying

2 types - spastic or flaccid bladder

100
Q

Urinary complications - Bladder dysfunction - target

A

bladder volume less than 500 ml to avoid distension

101
Q

Urinary complications - Bladder dysfunction - Urinary incontinence - management

A

Short term - can use condom catheters or adult diapers
Rule out infection - UTI
Adjust cath frequency and amount of fluid intake
Med

102
Q

Urinary complications - Bladder dysfunction - Urinary incontinence - meds

A

Anticholinergics
Alpha adrenergics
Cholinergics
Alpha blockers

103
Q

Surgical management

A 
Anterior cervical discectomy with fusion
Laminectomy
Discectomy
Fusion
Combinations
104
Q

Advances in care

A

Epidural spinal cord stimulation
Exoskeleton
Stem cell

105
Q

Epidural spinal cord stimulation

A

Neurostimulator and leads that run up the spinal cord
Implanted in abdomen
Delivers electrical signals to epidural space
Stops pain messages from reaching brain

Semester 5 PMNM Exam 8 (8 decks)

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